Abstract
Diabetes mellitus causes patients to develop sensory and motor neuropathy. Sensory neuropathy in patients with diabetes results in decrease in protective sensation. Motor neuropathy causes tendon imbalance. Tendon imbalance causes increased mechanical stress in the foot. This increased stress can cause foot pain and calluses and can progress to forefoot ulcers. Less often the ligaments fail before the skin, which can cause arch collapse and then a midfoot ulcer of Charcot foot. Foot pain in diabetics is common and frequently results from Achilles tendinitis, plantar fasciitis, midfoot arthritis and metatarsalgia. Tendon balancing can decrease stress in the foot which can relieve foot pain, heal forefoot and midfoot ulcers, prevent ulcer recurrence, and prevent progression of deformity in Charcot foot. Tendon balancing could prevent most of the amputations now being done on diabetic patients. Tendon balancing should be used earlier and more often in treatment of diabetic foot ulcers, foot pain and Charcot foot.